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Developmental Coordination Disorder
DSM-IV Diagnostic Criteria A'''. Performance in daily activities that require motor coordination is substantially below that expected given the person's chronological age and measured intelligence. This may be manifested by marked delays in achieving motor milestones (e.g., walking, crawling, sitting), dropping things, "clumsiness," poor performance in sports, or poor handwriting. '''B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living. C'''. The disturbance is not due to a general medical condition (e.g., cerebral palsy, hemiplegia, or muscular dystrophy) and does not meet criteria for a Pervasive Developmental Disorder. '''D. If Mental Retardation is present, the motor difficulties are in excess of those usually associated with it. Note: If a general medical (e.g., neurological) condition or sensory deficit is present, record the condition. Differential Diagnosis Specific neurological disorders Developmental Coordination Disorder must be distinguished from motor impairments that are due to a general medical condition. Problems in coordination may be associated with specific neurological disorders (e.g., cerebral palsy, progressive lesions of the cerebellum), but in these cases there is definite neural damage and abnormal findings on neurological examination. Mental Retardation If Mental Retardation is present, Developmental Coordination Disorder can be diagnosed only if the motor difficulties are in excess of those usually associated with the Mental Retardation. Pervasive Developmental Disorder A diagnosis of Developmental Coordination Disorder is not given if the criteria are met for a Pervasive Developmental Disorder. Attention-Deficit/Hyperactivity Disorder Individuals with Attention-Deficit/Hyperactivity Disorder may fall, bump into things, or knock things over, but this is usually due to distractibility and impulsiveness, rather than to a motor impairment. If criteria for both disorders are met, both diagnoses can be given. DSM-5 Diagnostic Criteria A'''. The acquisition and execution of coordinated motor skills is substantially below that expected given the individual's chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g., dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports). '''B. The motor skills deficit in Criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g., self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play. C'''. Onset of symptoms is in the early developmental period. '''D. The motor skills deficits are not better explained by intellectual disability (intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder). Differential Diagnosis Motor impairments due to another medical condition Problems in coordination may be associated with visual function impairment and specific neurological disorders (e.g., cerebral palsy, progressive lesions of the cerebellum, neuromuscular disorders). In such cases, there are additional finding on neurological examination. Intellectual disability (intellectual developmental disorder) If intellectual disability is present, motor competences may be impaired in accordance with the intellectual disability. However, if the motor difficulties are in excess of what could be accounted for by the intellectual disability, and criteria for developmental coordination disorder are met, developmental coordination disorder can be diagnosed as well. Attention-deficit/hyperactivity disorder Individuals with ADHD may fall, bump into objects, or knock things over. Careful observation across different contexts is required to ascertain if lack of motor competence is attributable to distractibility and impulsiveness rather than to developmental coordination disorder. If criteria for both ADHD and developmental coordination disorder are met, both diagnoses can be given. Autism spectrum disorder Individuals with autism spectrum disorder may be uninterested in participating in tasks requiring complex coordination skills, such as ball sports, which will affect test performance and function but not reflect core motor competence. Co-occurrence of developmental coordination disorder and autism spectrum is common. If criteria for both disorders are met, both diagnoses can be given. Joint hypermobility syndrome Individuals with syndromes causing hyperextensible joints (found on physical examination; often with a complaint of pain) may present with symptoms similar to those of developmental coordination disorder.